The Etiopathogenesis of Preeclampsia: Where Do We Stand Now?

Preeclampsia is a multisystem disorder that develops during pregnancy and is associated with severe complications for both the pregnant woman and her infant. It remains a leading cause of maternal and perinatal mortality and morbidity. Although it affects only 2–8% of pregnancies, over 70,000 women and 500,000 children die from it each year. The exact etiology of preeclampsia is unclear; it is often referred to as a disease of theories and hypotheses. This paper reviews the most significant hypotheses and studies that aim to explain the etiology of preeclampsia. This may help identify new research paths and concepts that could bring us closer to understanding the exact etiology of preeclampsia. The complexity of pathogenetic relationships and mechanisms, heterogeneous clinical presentations, and the development of underlying changes early in pregnancy when patients are clinically asymptomatic and appear healthy are among the main reasons for difficulty identifying the exact causes of preeclampsia. Furthermore, preeclampsia is specific to human pregnancy; there is no ideal animal study model whose results could be fully extrapolated to humans. A more holistic approach that combines all the information, hypotheses, and pathogenetic relationships may offer hope for understanding why preeclampsia occurs and how to prevent and treat it effectively. A better understanding of the precise etiology of the condition holds promise for developing new options for the early diagnosis, effective prevention, and modern causal treatment of preeclampsia. This would reduce the risk of severe complications in affected patients and could have enormous implications for clinical practice.